While most American physicians were incorporating more than 6,900 diagnostic code changes into their medical practices and electronic medical records (EMR) on October 1, the day updates took effect for a list of diagnoses the federal government requires most health care providers to reference, Dr. Fatima Jaffrey was free to devote her time to caring for patients.
Jaffrey, a direct primary care (DPC) provider in Oklahoma City, Oklahoma, bills her patients directly instead of through a third party, such as an insurance company or the federal Centers for Medicare and Medicaid Services (CMS). As a result, Jaffrey has no need to use codes recognized by insurers and CMS when she diagnoses patients.
Excluding CMS as a payer also frees Jaffrey from complying with the agency’s EMR requirements in billing patients. Instead of using EMR software designed to aid compliance with government billing rules, Jaffrey uses Atlas.md, an EMR platform built to facilitate patient care.
Back to Patient Care
After earning board certification to practice family medicine upon completing her residency at Dartmouth College, Jaffrey initially chose to enter health care administration.
Her training had convinced her the prevailing health care system’s focus on billing and EMR would have distracted her from adequately treating patients in active practice, Jaffrey says.
“I actually had no desire to take care of patients within that system,” Jaffrey said. “The information documented by the EMR is information for billing purposes, not information for patient care.”
Once Jaffrey discovered the direct primary care model, she left administrative medicine behind and opened her own practice, Crescent Medical, on December 1, 2014.
“Most of my work has been academic, in the field of teaching medical students and residents to be patient-centered,” Jaffrey said. “DPC was a no-brainer in my experience and training, and [it’s] the way doctors should be working with patients.”
Cracking the Code
From the beginning of her practice, Jaffrey has used the Atlas.md EMR and practice management software, which was developed by Dr. Josh Umbehr, a DPC provider in Wichita, Kansas.
DPC providers charge patients a flat monthly membership fee in return for an agreed-upon suite of preventive care services, tests, medications, and discounts on services not covered by the main agreement.
Jaffrey says the EMR structure approved by CMS and used by insurers doesn’t work for DPC physicians, because the DPC model prioritizes patient care over the collection of data to satisfy bureaucratic mandates.
“The EMR most often used by those of us in DPC is a completely different EMR and is structured for DPC, strictly for the care of that patient specifically—whatever we need to assess, diagnose, and treat our patients effectively,” Jaffrey said. “There’s no third party in the middle, no billing component other than the monthly payment the patient makes. We’re not paid by the code entered for the patient.”
‘Mind-Boggling’ EMR Fix
Umbehr says DPC providers and patients have found a cure for many of ailments of the country’s health care system.
“Everyone talks about how broken the health care system is and how expensive it is, but no one really fixes it,” Umbehr said. “Then we come out and completely change the model so that we can offer unlimited visits, no copays, free procedures, wholesale meds, and also labs for up to 95 percent savings, plus go to the employer and decrease employer health insurance premiums by 30–60 percent. That’s mind-boggling.”
When Dr. Josh, as Umbehr likes to be called, opened his DPC practice in 2010, he had no idea what he and his partners were doing with their record-keeping. For two years, his group used nine unique software platforms, none of which could sync with the others.
Umbehr and his partners created Atlas.md out of necessity in 2013 and are now treating patients more effectively and efficiently, Umbehr said.
“Codes aren’t health care,” Umbehr said. “They are industry bureaucracy. Surprisingly, we can care for patients without those codes and, in fact, have significantly more time to focus on the patient rather than on the paperwork.”
‘Bringing Physicians Back’
The combination of DPC and a patient-centered EHR platform such as Atlas.md is enticing retired physicians to return to primary care, Umbehr says.
“This model is actually bringing physicians back into the workforce,” Umbehr said. “Physicians are coming out of retirement because the current bureaucratic system drove them into early retirement, and excitement about the direct care model, which allows them to truly care for patients, is bringing them back out of retirement.”
Umbehr says the freedom and flexibility of direct-pay physicians to care for patients is attracting medical students to the field.
“Medical students are excited to go into primary care because they see what kind of relationship they can have with their patients,” Umbehr said.
Jaffrey says DPC is a haven for physicians and medical students who want to focus on treating patients instead of dealing with insurers.
“I would never go back to an insurance-based primary care system, and it’s my goal to pull as many students as I can into DPC practice,” Jaffrey said. “My observation is that it’s a breath of fresh air for learners to walk into this system. It feels great to take care of people in this way.”
Jenni White ([email protected]) writes from Oklahoma City, Oklahoma. Michael Hamilton ([email protected]) is managing editor of Health Care News, author of the weekly Consumer Power Report, and host of The Heartland Institute’s Health Care News Podcast.